Immediate Reconstruction of Distal Thumb Amputations Using Reverse Homodigital Dorsoradial Flap and the Amputated Part of the Phalanx

Abstract

Aim:The contribution of the thumb to hand function is indisputable. Treatment after an amputation injury should be aimed to restore the length, sensation, function and appearance of the thumb. This study aimed to present the surgical details and clinical outcomes of the reconstruction of the distal thumb amputations with a reverse homodigital dorsoradial flap using the amputated phalanx as a graft in heavy-duty workers, where functional gains are more prominent than appearance.Materials and Methods:Eight patients who underwent reconstruction using reverse homodigital dorsoradial flap and the amputated part of the distal phalanx due to traumatic amputation at the distal thumb, between 2016 and 2019, were evaluated retrospectively in this study. At the final follow-up, static two-point discrimination, key pinch strength, interphalangeal joint range of motion and Quick Disability of the Arm, Shoulder, and Hand score were measured.Results:Patients were analyzed. They had a mean age of 42.25 (range, 34-52) years and a mean follow-up of 20.4 (range, 16-24) months. At the final follow-up, the average static two-point discrimination was 7.5 (range, 6-9) mm. The mean injured side key pinch forces was 93% compared to the opposite side (range, 76-110%). All patients returned to their jobs.Conclusion:It was concluded that the reconstruction of the thumb distal tip amputations with the reverse homodigital dorsoradial flap using the amputated phalanx should be considered as an alternative to other reconstruction methods in patients with low aesthetic expectations, or irreversible damage to the nail bed.

Keywords

• thumb
• amputation
• reconstructive surgery